Key Messages:

• How a child understands and reacts to the death of someone close varies with age.
• You can help a child cope with the loss by having several simple, direct conversations and encouraging the child to express his or her feelings in a healthy way.
• Allow a child or adolescent to say goodbye in a way that makes him or her comfortable.

Children grieve differently than adults. Most children do not experience the sustained intense emotions experienced by adults. Children may show their sadness only occasionally and for brief periods, or may complain of physical discomfort, such as stomachaches, rather than expressing sadness. A child's grief comes and goes, and a child may experience it in a new way as he or she grows older or passes a developmental milestone, such as starting school or going on a first date. Even into adulthood, events such as graduating from college or getting married may trigger renewed grief.

How children understand death at different ages

Children at different stages of development have different understandings of death. Development influences the way children react to a loss and the type of support they need. Children's reactions are also influenced by other factors, including personality, previous experiences with death, and support available from family members. Note that children do not move abruptly from one stage of development to the next and that characteristics from each stage may overlap.

Infants (birth to two years)

• Have no understanding of death
• Are aware of separation and will grieve the absence of a parent or caregiver
• May react to the absence of a parent or caregiver with increased crying, decreased responsiveness, and changes in eating or sleeping
• May keep looking or asking for a missing parent or caregiver and wait for him or her to return
• Are most affected by the sadness of surviving parent(s) and caregivers

Preschool-age children (three to six years)

• Are curious about death and believe death is temporary or reversible
• May see death as something like sleeping—the person is dead but only in a limited way and may continue to breathe or eat after death
• Are characterized by "magical thinking" and understand the world as a mix of reality and fantasy
• Are naturally egocentric and see themselves as the cause of events around them
• Often feel guilty and believe that they are responsible for the death of a loved one, perhaps because they were "bad" or wished the person would "go away"
• May think that they can make the deceased come back if they are good enough
• Will worry about who will take care of them and about being abandoned
• Are still greatly affected by the sadness of surviving family members
• Cannot put their feelings into words and instead react to loss through behaviors such as irritability, aggression, physical symptoms, difficulty sleeping, or regression (such as bed-wetting or thumb-sucking)

School-age children (six to 12 years)

• Understand that death is final, but see it as something that happens only to other people
• May think of death as a person or a spirit, like a ghost, angel, or a skeleton
• Understand that death is universal, unavoidable, and will happen to them (by age 10)
• Are often interested in the specific details of death and what happens to the body after death
• May experience a range of emotions including guilt, anger, shame, anxiety, sadness, and worry about their own death
• Continue to have difficulty expressing their feelings and may react through behaviors such as school phobia, poor performance in school, aggression, physical symptoms, withdrawal from friends, and regression
• Still worry about who will take of them and will likely experience insecurity, clinginess, and fear of abandonment
• May still worry that they are to blame for the death

Teenagers (13 to 18 years)

• Have an adult understanding of the concept of death, but do not have the experiences, coping skills, or behavior of an adult
• May "act out" in anger at family members or show impulsive or reckless behaviors, such as substance abuse or fighting in school
• May experience a wide range of emotions, but not know how to handle them or feel comfortable expressing them
• The reality of death contradicts a teenager's view of himself or herself as invincible, and teenagers may question their faith or their understanding of the world
• Developmental issues of independence and separation from parents can interfere with the ability to receive support from adult family members
• Coping strategies may create tension with family members, as adolescents may cope by spending more time with friends or by withdrawing from the family to be alone

Ways to help

Explaining death should be done in simple, direct terms with information that is geared to the child's developmental level. Children cannot reflect on their thoughts and emotions like adults, so they will need to have many short conversations. Adults may need to repeat the same information many times, and children may ask the same questions repeatedly as they try to make sense of difficult information. Children and adolescents need honest information and other types of support.

• Explain death using real words like "died" rather than confusing euphemisms like "gone to sleep." You can explain death by saying that death means the person's body has stopped working or that the person can no longer breathe, talk, move, eat, or any of these things he or she could do when alive.
• Share your family's religious or spiritual beliefs surrounding death.
• Make sure children understand that they are not to blame for the death and that the deceased person is not "coming back."
• Provide lots of verbal and physical affection and reassure children often that they will continue to be loved and cared for.
• Use books, drawing, or role-play games to help younger children to understand death and  learn to express themselves.
• Encourage children to ask questions and, as an adult, make attempts to answer them honestly and directly; if you don't know the answer to a question, help the child find the answer.
• Encourage children to talk about their emotions and suggest other ways they can express themselves, such as writing in a journal or drawing a picture.
• Without overwhelming them, share your grief with the child; expressing your emotions can encourage the child to share his or her own emotions.
• Help children and adolescents understand that normal grief involves a range of emotions, including anger, guilt, and frustration, and that their emotions and reactions may be very different from those of adults.
• Reassure children that it is normal for the pain of grief to come and go over time and that periods of intense grief are not always predictable.
• Encourage adolescents and older children to talk to an adult outside the family, such as a teacher or a clergy member; consider an age-specific bereavement support group.
• Keep routines and caregivers as consistent as possible and continue to set limits on behavior. Care, consistency, and continuity give children a sense of safety.
• Encourage time spent with friends and involvement in age-appropriate activities.
• Reassure children that it is never disloyal to the deceased to feel happy and to have fun.
• Speak with a grief counselor, child psychologist, or other mental health professional if you are concerned about a child's behavior.

Significance of the relationship with the deceased

The grieving process of the child is more intense when the relationship between the child and the person who died was close. For instance, the death of a parent or a sibling has a much greater impact than the death of a grandparent whom the child rarely saw. Beyond the immediate sadness, the significant influence of a parent or sibling on the ongoing development of a child means the effect of his or her death will be felt repeatedly as the child grows up. The death of a parent or other close family member also directly changes the child's day-to-day life. Family routines and roles change, such as a surviving parent having to return to work and spend less time at home. These changes represent significant losses and add to children's overall grief.

Some aspects of the death of a family member with cancer may actually make a child's life easier. Perhaps the death of a sibling means that parents won't have to spend all of their time at the hospital anymore. It is normal for children to feel some relief when a family member dies after a long or difficult illness. Parents should help children realize that these feelings are normal and that they should not feel guilty for having them.

Memorial services and remembering the person who died

Children as young as three years old understand the concept of saying goodbye and should be allowed a choice in how they say goodbye to a loved one.

• Preschool-age and older children should be given the choice of attending memorial services, but shouldn't be forced to attend.
• Some children may want to attend a memorial service, but not a viewing or burial.
• Older children and teenagers should be allowed to help plan memorials.
• Talk to children about what will happen at a service; consider visiting the church or cemetery beforehand.
• Ask a trusted adult to help take care of young children at a service or accompany a child who decides he or she wants to leave early.

Help the child understand that an important person is never truly gone because he or she lives on in our memories. Parents who are terminally ill sometimes leave letters, videos, or photograph albums to help children remember how important they were in the life of the deceased person. Children can also create their own memory album or box filled with pictures and other special items. For younger children, most of their knowledge of the deceased person will come from memories of other family members. Talk about the person often and remind children of how much the deceased person loved them. Over time, children can come to understand that they would not be who they are without the influence of the special person who died.

More Information

Understanding Grief and Loss [2]

Talking With Your Children [3]

Talking With Your Teenagers [4]

How to Cope With Losing a Sibling to Cancer [5]

Additional Resources

American Cancer Society: Grief in Children [6]

National Cancer Institute: Loss, Grief, and Bereavement (PDQ®) [7]

KIDSAID [8] (a website where kids can cope with grief and loss)